Great Western Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question as requires improvement. At this assessment, we rated this key question as good. This meant people’s needs were met through good organisation and delivery.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service made sure people were at the centre of their care and treatment choices wherever possible. We saw that medical staff took care to include patients and took action to contact patients' next of kin to keep them informed of plans for treatment and care.

People with specific care needs were supported as individuals and those needs met. Staff undertook risk assessments to identify specific needs such as nutrition, hydration, mobility, falls risk and frailty score. Staff worked together across teams and disciplines, and made reasonable adjustments to help patients access services. We heard examples where patients were too scared to attend hospital for treatment and how the service worked together in the best interests of the patients.

Another example given was how a ward had facilitated a wedding for a patient who was on the end of life pathway. The ward staff created an area for the wedding and guests, decorated the ward, provided a cake and allowed the patient’s family dog to attend.

The service used recognised guides and aids to support patients. For example, a ‘This is Me’ passport was in use for patients living with dementia.

There was a multi faith room available for people and the chaplaincy had good access to all faith leaders.

We saw positive interactions between staff and patients. Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Processes were in place to support joined up care. Discharge planning process was supported with continuity of care once the patient was discharged. Access to specialist teams such as the Learning Disability Team, the Psychiatric Liaison Team, and the Dementia team supported staff to ensure patients received continuity of care for their other conditions, rather than just a surgical concern they were admitted with.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Care plans reflected physical, mental, emotional, and social needs of patients including those related to protected characteristics under the Equality Act. Staff were responsive to changes in patients after their surgery. Staff took needed action when patient needs changed. For example, we reviewed records on the ward and saw pain assessments were adjusted during the first 24 hours on the ward.

Pre-operative information was available to patients through the provider’s website which set out the different specialities available. Staff provided leaflets to patients which gave them information to consider before their visit. However, a recent consent audit had identified patients were not always given these leaflets to review.

Post operative information was made available at the conclusion of patient’s care, this included any onward recovery information and follow up appointments. Managers told us the bookings team were available to answer any follow up queries not answered at the initial discharge.

Information was provided and available in a range of community languages. Whilst posters displayed around the hospital were predominantly in English, information was available in a range of different languages on the trust's website or by request.

The service had access to interpreter and translation services, including British Sign Language. Information provided by the service met with Accessible Information Standard. The Accessible Information Standard (AIS) is a legal requirement for organizations providing NHS or publicly funded adult social care. It ensures individuals with disabilities or sensory loss receive information and communication support in a way they can understand and access.

Staff knew they could ask for interpreters through a designated language line and explained they would use this for clinical information and processes. Sometimes they used a less formal approach and used staff from around the hospital to provide interpretation for patients.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Information about how to give feedback about care and treatment was detailed on the trust website. This included compliments, concerns and complaints feedback processes. A trustwide complaints policy gave staff guidance about managing and responding to complaints.

Review of complaints and the services responses to patient complaints showed the service provided answers to questions, an explanation of actions they were taking to make improvements and, where appropriate, gave an apology to the patient.

Patient feedback forms were available on wards. Wards had “you said, we did” boards which detailed the action they had taken in response to patient comments. An example given was a patient provided feedback about how they felt when placed in one of the escalation beds. They told staff they felt claustrophobic in the smaller space. Staff now discuss with patients about they might feel about being in a smaller space and, if possible, how they can mitigate their concerns.

The service also used the friends and family test to get feedback and support improvements to the service.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The service, managers and staff worked hard to reduce the number of cancelled surgeries. Data provided by the service showed that in December 2024, a total of 68 patients had surgery cancelled on the day of surgery. In January 2025 94 patients had their surgery cancelled on the day of surgery and in February 2025 the figure was 67.

Reasons for cancellation of surgery were split into 3 categories: clinical, non-clinical or patient initiated. Non-clinical cancellation reasons for December 2024 (21 of 68 cases), January 2025 (27 of 94 cases) and February 2025 (17 of 67 cases) were varied. The most frequent were: bed issues (8 – December), bed issues and theatre overrun (both 7 – January) and no surgeon available (6 – February). Patient initiated cancellations were mostly recorded as ‘Patient Did Not Attend’ or ‘Patient Unwell’.

Bed capacity on wards meant some patients remained in recovery longer than they needed to, some waited up to 4 hours for a ward bed. Staff reported when the day surgery unit had overnight patients from other areas of the hospital, the recovery area was utilised to admit and discharge patients for surgery. This impacted the effective flow of patients through the surgical service. Staff also reported it negatively affected their morale. We saw this situation during our inspection.

There were no overnight stays in recovery. Patients who needed to stay overnight for clinical reasons were transferred to wards for ongoing care and management.

As a result of poor flow through the surgical service, patients experienced delayed admission to surgical wards from the emergency department. Data provided by the trust showed patients frequently spent more than 4 hours in the emergency department after the decision to admit to a ward.

The service was working to reduce the number of patients waiting for treatment. Data provided by the service which related to surgical services showed significant reduction in the number of patients waiting over 65 weeks to be seen and treated. Despite this numbers of patients on the waiting lists, the service was improving its position.

The NHS constitution dictates that patients have the right to begin consultant-led treatment within a maximum of 18 weeks from the time they are referred by their GP. Patient waiting times for planned surgery were monitored and reviewed at governance meetings. The service carried out harm reviews to identify and act on harm patients were exposed to because of delayed surgery.

The service undertook a review of fractured neck of femur (NOF) cases to see if they could improve patient outcomes following surgery. The review determined NOF patients, who required surgery, should be the first patient on the trauma operating list (this was called the ‘Golden Patient’). To support this, a standard operating procedure was developed and implemented to protect (or ‘ring-fence’) 2 beds specifically for acute admissions of NOF patients. Data from the trust showed demonstrated an improvement in the timeliness of surgery for patients with a NOF.

The environment on wards supported people with dementia to have equal access to facilities. Toilet and shower rooms had dementia friendly labelling. Door frames and toilet seats were of a contrasting colour to the walls and floors to make them clearly visible for both patients with dementia and for patients who were visually impaired.

Staff took account of both physical needs and cognitive needs including specific fears and preferences associated with healthcare conditions. This included Learning Disabilities, Autism Spectrum disorder and Neurodiverse needs. Managers and staff had training to show awareness of these needs and provided space or rooms which would be more suitable for patients who needed a quieter environment for their recovery.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff completed Equality, Diversity and Inclusion training as part of their mandatory training. The service also highlighted the Oliver McGowan training for Autism and Learning Disabilities which they felt was valued and encouraged reflection. Staff followed processes that supported them to deliver care and treatment that did not put patients with protected characteristics at disadvantage.

The service gave examples of how they had put in place tailored plans to support patients with a learning disability to access the service and receive their care and treatment. An example included a patient with a severe learning disability who attended the hospital for treatment under a general anaesthetic. Their treatment was tailored to meet their individual and specific needs. This included a plan to support the patient getting from the carpark to the ward in a way that did not elevate their anxiety. As part of the treatment plan, interventions normally carried out for a conscious patient, were safely adapted to be delivered while the patient was anaesthetised. This reduced the amount of distress that this patient experienced, during this episode of care.

For patients living with dementia, the service used the nationally recognised “This is me” document. ‘This is me' helps health and social care professionals better understand a patient’s needs, preferences and values beyond their dementia diagnosis. This can help staff to deliver care that is tailored to the person's needs. Used effectively, it can help to reduce distress for people with dementia and their carers. It can also help to overcome problems with communication and prevent more serious conditions such as malnutrition and dehydration.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff in pre-assessment made a full assessment which focused on ensuring patients were well enough to have their chosen surgery. Staff told us part of this role was giving lifestyle advice if certain clinical readings were not suitable for safe surgery. For example, when surgery was not a viable option at that time due to poor cardiac health or other medical conditions. Staff told us they approached these conversations in a sensitive manner and wanted to support patients to feel as well as possible prior to their surgery.

Care plans reviewed accurately reflected patients advanced planning decisions. Staff provided examples of how they had supported patients to have a good death and in accordance with their wishes.